Patients, family, friends, and carers can play an important role in the safe use of these medicines and in reducing the risk of harm. Please share this information with them.

Opioid medicines and the risks

Opioids are a type of medicine that help relieve pain. They are very effective over short periods to relieve moderate to severe pain. They are also sometimes prescribed for long periods to relieve pain in serious conditions.

Examples of opioids include codeine (including co-codamol), tramadol, fentanyl, and morphine.

Opioids have a serious risk of addiction, especially with long-term use. The person who prescribed an opioid or your pharmacist should explain how long it is safe for you to take the medicine.

For further information on using opioids safely, and a full list of possible side effects, read the patient information leaflet (PIL) that came with your medicine, and keep it handy. PILs for each opioid are also available on the MHRA product information list.

Taking opioid medicine safely

You should only take the medicine as directed. In particular:

do not increase the dose or take an extra dose
do not take any other medicines that contain opioids to “top up” your pain relief
do not take opioid medicines if you are pregnant without health professional advice

Do not do any of these without advice from the person who prescribed the medicine or from a pharmacist. Taking more than you should can lead to overdose.

Babies born to women who took opioids during pregnancy may need to be carefully monitored for withdrawal effects after birth. Talk to your doctor or midwife if you are worried.

If you have any questions about your opioid medicine or side effects, or if you do not understand how to take your medicine, talk to the person who prescribed your opioid medicine or to a pharmacist. Keep talking to them about your pain. There may be different treatments that can help.

Do not allow other people to take any opioid medicines given to you. Your medicine has been prescribed or specifically recommended for you by your doctor or pharmacist and can be dangerous if taken by other people. It could even cause a fatal overdose.

Always keep medicines out of sight and reach of children.

Signs of addiction and what to do

Addiction can happen gradually. It can make you feel that you are no longer in control of how much medicine you need to take or how often you need to take it. You might feel that you need to carry on taking your medicine, even when it doesn’t help to relieve your pain.

If your pain is becoming difficult to manage, talk to your doctor. Your body may have stopped sensing the pain-relieving effect of your opioid. This is called ‘opioid tolerance’. It could be an early warning sign that you are at risk of becoming addicted.

Signs that you may be addicted to opioids include:

craving for the medicine
feeling that you need to take more medicine than prescribed or as instructed on the pack, even though the medicine is causing unwanted effects on your overall health (for example, some of the withdrawal side effects in the next section)
feeling that you need to take additional medicines containing opioids or other pain relief medicines to achieve the same relief
taking opioid medicines for reasons other than pain relief: for instance, to ‘stay calm’ or ‘help you sleep’
experiencing withdrawal side effects when you stop taking the medicine suddenly (see below)

If you notice any of the above, talk to your doctor or a pharmacist.

Safely stopping opioid medicines

If you have been taking your opioid medicine for a long time, do not stop taking it suddenly because this may cause unpleasant withdrawal side effects. It is important to get the right help and support when you are ready to stop taking your medicine.

Talk to your doctor, nurse or a pharmacist.

They will be able to help you to come off your opioid medicine slowly to reduce unpleasant withdrawal side effects. Safely coming off opioids can take a long time. Every person is different. Take any unused opioids back to a pharmacy for safe disposal.

Withdrawal side effects may include a combination of the following:

shivers
diarrhoea
difficulty sleeping
sweating
widespread or increased pain
body aches
irritability and agitation
nausea and vomiting

If you experience any of these, talk to the person who prescribed your medicine or a pharmacist.

Effects of taking too much opioid medicine

Taking too much opioid medicine is called an overdose, whether it’s intentional or not. This can be very serious and may cause death.

Some of the signs of an overdose include:

confusion or hallucinations
slurred speech
lips or fingernails are blue or purple
poor coordination or balance
unresponsive or unconscious
heavy or unusual snoring
difficulty breathing or no breathing
very small pupils in the eyes

Your family, friends, and carers should know these signs so they can take immediate action.

If you think that you or someone else has taken too much of their opioid medicine, dial 999 immediately.

If you experience side effects to your opioid medicines you can report these directly to the MHRA on the Yellow Card website, via the free apps (‘Yellow Card Scheme’ in the Google Play Store or ‘Yellow Card – MHRA’ in the Apple App Store), or by phoning the free phoneline (0800 731 6789).

Opioid medicines and the risk of addiction